Yes, but what methods can we use and what guidelines should be used and will Insurance companies allow necessary follow up?
Phlebology Doctors Ask : Should we use Surgery? Foam Sclerotherapy? or Heat? When should we use compression?
Most patients need secondary treatments after ablation because of their disease process: some of the refluxing veins are too small or tortuous, they have bulging skin veins that would result in hard sclerosed coagulum after cosmetic injections and lead to matting and staining which is a real problem for patients at least in the short term of their life.
There are real needs for perforating veins to be treated if they result in unhealed ulcer patients, but most post ablation patients do not need normal perforators closed to be efficiently treated.
ONE TRIAL showed why perforators were closed:
University of Pittsburgh group (Dillavou) in a Retrospective Review, looked at 73 ulcers (avg 28 mos duration), all with perforator incompetence, w/o superficial incompetence
- ~ 1/3 from post deep vein thrombosis( DVT), 1/3 had Deep Vein Incompetence( Reflux)
- They used STS/Poli foam + foam pads from STD pharmacy plus compression wraps
- Multiple injection sessions of ultrasound guided injections into the damaged, refluxing perforating veins.
- Mean follow up 30 months: 32 (52%) healed; 30 (48%) non-healed
- Kiguchi M, et al. J. Vascular Surg 2014;59:1368-76
Other methods of closing perforators are with Closure Fast (RF), Varithena, and VenaSeal ( Cyanoacrylate adhesive) 2 studies below:
Cyanoacrylate adhesive was shown to be effective in a European Multi-center Trial with 70 patients because they preferred no tumescent anesthesia and no post procedure compression garments. 93% of patients were “recanalization free” at one year: Proebstle, et al JVS Vand L 2014, 2, 1: 105-106 and a VeClose study in the USA of 222 patients where they compared Radiofrequency to Cyanoacrylate adhesive and they were similar 96% vs 99% Study in JVS 2015 with Morrison, N and Gibson, K
Compression garments and compression bandages come in all shapes and sizes. Insurance companies require use of compression and other conservative treatment modalities sometimes for months before allowing surgery or endovenous procedures but they won’t often reimburse. Compression is level 1 standard of care for ulcers but with proper use may prevent these ulcers in the first place. To be continued…..
We will talk in future blogs more about compression but for most post op procedures (except VenaSeal glue), compression wraps, stockings, socks or elastic velcro wraps properly fitted and applied help the healing process and limit the inflammatory processes that can lead to matting, staining and phlebitis.
Come talk to us @Morrison Vein Institute 480-775-8460 Sudies compliments of Dr. Nick Morrison’s slides for lecture in 2015.
Venous patients come to see a doctor about their veins for many reasons:
Cosmetic or surface veins may bring them for a consult because they are embarrassed to wear clothing that reveals them to others.
“Veins are inherited” many women say that their Mom, Dad, Grandparents had “awful legs” and they don’t want to get that way…
“Veins Hurt” and many doctors or family members haven’t believed them. They are told it is a “natural part of aging”, the symptoms are all in their head, “everyone’s legs hurt” when they stand at their job, restless legs are inherited but not related to their veins, and even worse they didn’t know that deep vein thrombosis, pulmonary embolism and multiple miscarriages could be related to their thrombophilia and vein disease and could have been prevented in so many with preventative treatments and compression stockings.
Varicose veins and spider vein treatments have improved over the last 15-20 years. They heard horror stories about vein stripping and painful saline injections. They saw people suffer with recurrences even after stripping and injections and didn’t know why? Who should they pick and what therapy should they have?
Vein ruptures: the typical one is a women hits a fragile vein while shaving, or a man knocks against a vein with lifting at a job and the result is dramatic at first and they usually seek attention right away.
PATIENTS MUST THEN FIND A VEIN DOCTOR, A PHLEBOLOGIST WHO HAS EXPERIENCE IN ALL TREATMENT MODALITIES:
RADIO-FREQUENCY OR LASER ABLATION TECHNIQUES WITH HEAT
CHEMICAL ABLATION USING FOAM SCLEROTHERAPY FOR ULTRASOUND GUIDED TREATMENT OF THE REMAINING REFLUXING VEINS AFTER SAPHENOUS VEIN CLOSURES
VENASEAL, CYANOACRYLATE ADHESIVE WHICH REQUIRES NO HEAT, NOR LOCAL TUMESCENT ANESTHESIA
- SURFACE VEIN SCLEROTHERAPY USING FDA APPROVED MEDICINES CALLED ASCLERA OR STS ( SODIUM TETRADECHOL SULFATE) OR VARISOLVE FOAM FOR SPIDER VEINS, TELENGECTASIAS, VENULECTASIAS THAT COULD RUPTURE, AS MENTIONED ABOVE.
- AMBUALTORY PHELBECTOMY: MICROSURGERY DONE IN OFFICE TO REMOVE BULGING SKIN VEINS INSTEAD OF JUST INJECTING THEM OR LEAVING THEM, FAR WORSE.
NOW ALL THESE PATIENTS NEED AN EXAMINATION FIRST WITH SPECIFIC VENOUS ULTRASOUND BY A VEIN SPECIALIST RVT OR RVPh (Medical doctor)
THEN THE PROCESS OF TEACHING ABOUT ALL THE THERAPIES AVAILABLE AND THOSE THAT ARE UNIQUE TO THE PATIENT.
THIS IS WHERE THE REAL TALENTS OF THE PRACTICE COME IN BECAUSE THEY HAVE TO TELL THE PATIENT WHAT IS NEEDED AND THEN TELL THEM WHAT THEIR INSURANCE COMPANIES WILL ALLOW OR WILL NOT!
4-6 HOURS OF TEACHING AND HAND HOLDING FOR THE PATIENTS, BEGINS WITH HOURS OF WORK TO SEE IF INSURANCE IS EVEN AN OPTION AND IF NOT WHAT ELSE??
SO MY ENDING IS: THERE IS A DIFFERENCE IN VEIN CLINICS AND WE WANT OUR PUBLIC TO SEE THE DIFFERENCE THAT EXPERIENCE MAKES, COMBINED WITH A REMARKABLE TEAM OF RNS AND PATIENT ADVOCATES WHO WILL WALK VEIN PATIENTS THROUGH THE FIRST, SECOND, THIRD PART OF VEIN CARE AND REMAIN WITH THEM THROUGH THE JOURNEY OF GENETIC VEIN DISEASE WITH A COMPREHENSIVE APPROACH TO HEALTHY LEGS!
COME TALK TO US @MORRISONVEIN 480-775-8460
Asclera (Polidocanol), STS, Glycerin, Hypertonic saline are medicines offered in many vein clinics for the last 20 years but patients and providers haven’t been thoroughly educated about the positive and negative attributes of each method. When Polidocanol was FDA approved a few years ago, the company raised prices to equally expensive STS that was already on the market and closed the doors for providers to buy equally safe and pure products from overseas. Thus compounding pharmacies starting filling the holes and many were not aware of the impurities in IV injectables until there were some complications with other intravenous compounding agents in the US.
Many oral and crème based nutraceuticals don’t have the risks of compounded IV medications. We should be given the best products on the market and not worry about severe complications. In future blogs, I will present some of the studies being done to protect patients and their providers.
At Morrison Vein Institute, we count on high satisfaction and success ratings, with fewer side effects, so we use FDA approved STS and Polidocanol from official company distribution centers. Come in for a screening and see if you are a candidate for cosmetic or medical treatments and we will be glad to explain the difference.
Morrison Vein Institute has been at the cutting edge of new modalities. We also have been principal investigators during FDA trials so we get a head start on our competition.
Dr. Nick Morrison, MD FACS, FACPh, has been the president of the American College of Phlebology ( Veins and Lymphatics now), National Veins and Lymphatics Foundation and currently the president of the world organizaion of Phlebology specialists called UIP.
Presented here in bullet form so you have insight on the various treatments and then come in for a venous duplex ultrasound to find out which one is right for you. Each blog will then cover these in more depth:
Tumescentless, NO Lidocaine anesthesia needed means less injections to the patient
Ablation techniques to treat venous disease, saphenous veins and tributaries with reflux disease:
- Non- Thermal, non tumescence Ultrasound-guided foam sclerotherapy:
- Meaning no laser or radiofrequency which would have required the anesthetic called tumescent anesthesia
- Cyanoacrylate adhesive called VenaSeal, which likened to an implantable glue requiring no anesthesia and no support stockings after procedure
- MOCA ( Mecanical Occlusion Chemically Assisted), ClariVein®OC is a specialty infusion catheter for the occlusion of incompetent veins in patients with superficial venous reflux.
- Thermal, Non- tumescence: Homium Laser plus the use of foam sclerotherapy using Asclera or STS ( Sodium Tetradechol Sulfate)
- Varithena, manufactured foam, 1% Polidocanol with co2/o2 Gas FDA approved 2014
Traditional surgical methods, newer surgical modifications, radio frequency, laser, and tumescentless endovenous ablation are generally safe.
Intraoperative and postoperative complications are infrequent and generally are less frequently seen with endovenous ablation procedures than with more traditional surgical procedures, like stripping or Trivex invasive procedures needing long convalescence and usually performed in an operating room with much bigger costs.
Morrison Vein Institute is committed to careful follow up and adjunctive treatments, like ultrasound guided foam sclerotherapy, phlebectomy for large bulging varicose veins on the skin and cosmetic sclerotherapy to prevent imminent phlebitis, vein rupture, itching, restless leg, cramping still possible with a myriad of skin veins left on the skin after medical ablations.
Call Morrison Vein Institute: 480-775-8460 for a consult, Compression stocking fitting and after the Venous Ultrasound meet with our Doctors for your unique vein mapping and treatment protocol. Thank You, Terri Morrison RN BS and Nick Morrison MD for this excerpt from his national presentation.
Inflammation caused by vein disease is a problem a majority of patients face.
Slide above is from the International Compression Club: “Comparison of below knee with above knee stockings for the prevention of leg volume increase and symptoms that occur during prolonged standing”:W. Blättler, HJ.Thomae, F.Amsler, Switzerland I THANK YOU One of many studies ” patients have pain with varicose veins” and how do we treat?
Chronic venous insufficiency causes: “Inherited weakness in venous valves of the legs” allowing blood to flow backward down the legs and pool with prolonged standing or sitting. There are chemical changes occurring with the release of cytokines, MMPS and the inflammatory processes. These can signal different symptoms to the patients: heaviness, tired, swelling, cramping, itching, or local tenderness. If our patients are uninformed about the side effects of their disease process, these symptoms and inflammatory processes increase without treatments.
First we encourage patients to have a diagnostic, venous ultrasound scan which gives us a map of their diseased veins so we can propose appropriate treatments.
Second, we can prescribe good quality, well fitted compression stockings to wear until they decide on treatment plans or while their insurance company makes them wait several weeks to months trying “conservative therapy.” As the slide indicates, when patients get chronic, untreated, inflammatory symptoms of varicose veins they assume they should put up with it…. not knowing that good compression stockings, calf muscle pump exercises, alternated with leg elevation could help these progressive problems while they wait for treatment. Even light weight, 20 mmHg of pressure with a good stiffness index can cause a massaging effect which can decrease edema and that feeling of fullness at the end of the day.
Third, treat the patient with anyone of our toolbox of ” state of the art ” vein therapies: endovenous ablation using heat like ( radio frequency or laser) or liquid or foam sclerosants, using ultrasound guidance, FDA approved, MOCA ( Clarivein), microphlebectomies, and the brand new FDA approved glue( VeClose). When the medical issues are treated first, then we can inject or laser the remaining skin veins called cosmetic vein therapy.
Fourth, our MD, RN, MA, Sonographer team, works with all our colleagues to teach our patients about a lifelong plan to follow up annually and keep “Vein Healthy Legs.” As the slide concludes, “pain can be memorized as bad feelings and impair quality of life.” There is no reason to suffer the pain of vein disease. Come see us @MorrisonVein 480-775-8460 We can help you get a healthy start.
Ask us about VeClose
Our 5th consecutive year in Nicaragua, 25 years with our Morrison / Amigos group of volunteers. [Veins and Lymphatics 2015; 4:4851]
A phlebo-lymphology humanitarian trip to Matagalpa, Nicaragua https://www.academia.edu/27533997/A_phlebo-lymphology_humanitarian_trip_to_Matagalpa_Nicaragua?s=t via @academia
Each year, Nick Morrison MD and Terri Morrison RN as co-founders of Morrison Vein Institute and with our former multidisciplinary group of Doctors, Nurses, Sonographers, and a multitude of volunteers founded Amigos de Salud, Inc. a 501C3 charity without any paid administrators. We have volunteered in Ecuador, Mexico, Peru, Costa Rica, and Nicaragua. Our numbers grew to a 100 volunteers one year, and then we figured out to split off and multiply the good we could do. The last 5 years, we have had the benefit of the Big Hearts of The Fara Foundation of Austin Texas/ Nicaragua who help us coordinate our trips and do everything they can with their donors and their own money to help us take care of the poor there for free. They pre-screen thousands of patients for us to find the patients with the worst vein disease, leg ulcers, venous malformations so that we can consult and treat 800- 900 patients in 6.5 days. Our friends the colorectal surgeon and his wife, a doctor of Audiology Drs. Venkatesh came a few weeks before us so the staff wouldn’t be overwhelmed.Then, the Fara Foundation pays local doctors to follow up caring for our patients with the teaching we started and the supplies we can leave them from our generous donors and from all the Doctors, Nurses and Sonographers we bring from around the world. This year we were represented by Italy, Australia, Argentina, Ireland and USA docs and teams from several states. Many docs bring their mature teens to help with translation and all kinds of physical labor and venous assistant maneuvers.
Compudiagnostics has provided our diagnostic and treatment ultrasound for 20 years as well as supporting us in kind on these volunteer trips. Our Morrison Vein and Compudiagnostics staff have taken turns going to make this all possible as well as months of collections from our donors to packing for weeks on end… In the following weeks I will be thanking all our donors in our Morrison Vein facebook page! I just couldn’t wait to share and thank everyone! We are so grateful.
Fox 10 was at our office interviewing Dr Morrison and a patient of ours about CoolTouch Laser to treat veins. Thanks to TV and social media, patients can learn about new therapies to treat their veins.
In the last 2 years, the FDA has approved a New Foam called Varisolve ( Varithena) for treating venous insufficiency, in other words a way to treat or close the leaking, saphenous veins that used to be stripped out! This isn’t used for the surface, cosmetic, skin veins that we can see. This replaces therapies like laser or radio frequency ablation or MOCA, Clarivein type procedures.
The other approved last November is VenaSeal, Closure by Medtronic. ( medtronicendovenous.com) This procedure is the only non thermal, non- tumescent, non-sclerosant procedure that uses a proprietary adhesive delivered by a doctor using their kit to deliver in the saphenous vein, to close the veins with faulty valves. Patients who fear anesthetic, heat, pain etc will prefer this method and if this is the only treatment needed, the patient won’t need compression stockings that day and may return to work or play.
COME SEE US AT MORRISON VEIN INSTITUTE TO EVALUATE YOUR VEINS: 4807758460 firstname.lastname@example.org or email@example.com
Venous Insufficiency (VI) can be a life-altering medical condition and should be evaluated by a specialist. VI occurs when blood pools in the veins of your legs, making it difficult for the blood to return to your heart for recirculation.
It is estimated that 40 percent of people in the United States (often unknowingly) suffer from chronic venous insufficiency. Venous insufficiency that presents itself as spider veins or varicose veins may be a sign of more significant underlying venous disease.
Venous insufficiency can be the result of heredity, age, gender, weight, history of deep vein thrombosis (blood clots), pregnancy, inactivity or occupations that require prolonged sitting or standing. In addition to the visual signs, the symptoms of vein disease include: leg pain, aching, or cramping, fatigued or heavy-feeling legs, itching/burning, swollen ankles, restless legs, and—in severe cases—ulcers.
Please use this tool to help you decide whether a medical assessment by a physician who specializes in the treatment of venous insufficiency would benefit you.
Please check as many of the following boxes as appropriate:
1. At the end of the day, do your ankles or legs usually swell?
2. Have you noticed any skin discoloration around your ankles?
3. Do you have ulcers or open wounds near your ankles that just don’t seem to heal?
4. Have you noticed bulging or knotty veins in and around your private areas (buttocks, genitals)?
None of these apply to me.
Recent randomized trial in Ferrara, Italy, by Sergio Gianesini MD, et all, Int. Nat. Angiology March 2016 studied forty men and women golfers with the median age of 48 years old, golfing for 18 holes and divided them in groups with no compression, 18 mmHG compression ( our light weight compression in the US.), and 23 mmHg of compression ( our Class 2 Medical sock or stocking. A standard venous ultrasound, echo color doppler was used and water testing called Plethysmography. Also questionnaires, for assessments of fatigue before and after were used.
Those participants who had no compression reported and with testing proved that they had an increase in leg volume of at least 5%, ie:swelling and fatigue. The 18 mmHg only reduced the volume by 1% but the 23mmHg stockings reduced the leg volume by 4% and significantly reduced fatigue and tiredness at the end of 18 holes.
This is only one of hundreds of new studies around the world of “Phlebology = Vein Care” that will finally encourage athletes of all ages, sizes, shapes to use compression socks for healthier legs, help our venous circulation and improve our recovery times between our sports activities, and our daily lives. Medical compression stockings properly fitted can prevent even major life events like deep vein thrombosis ( blood clots) and pulmonary embolism, leg ulcers and minor symptoms too.
Call today 480-775-8460 @Morrison Vein Institute
Saying that varicose veins are unsightly is lending a gentle term to a condition that most of us would describe more vividly: embarrassing, excruciating, and just plain ugly. Even so, many women and men have endured the bulging veins, heavy cramping, restless legs, and even limited activities, blood clots and sores rather endure treatments that they thought were “too painful, too restrictive, and maybe would not work anyway.”
20 years ago we started Morrison Vein Institute, called Vein and Laser Center of Arizona at that time. We quickly eliminated the need for vein stripping with in-office minimally invasive procedures like ligations, injections and micro procedures to remove large veins. Phlebology has since then become a specialty, recognized by the AMA and we have tried to organize as a specialty and teach ourselves and patients about the inherited disease called venous insufficiency.
There is good news for the 40 million people (27 million of them women) whom the National Health Institute says has a problem with varicose veins. this disease causes problems when the valves inside the veins malfunction and gravity forces blood to pool in the vein rather than travel on to the heart. This back flow and pooling of blood can lead to itching, swelling, achiness, skin color changes, constant pain or even sores or blood clots. Now, we have an easy way to diagnose vein disease in each patient and give them a specific treatment plan of veins to be treated and how.
We have many treatments to offer patients, even 2 new FDA treatments in the last 2 years: Varithena, FDA Approved Foam and the VenaSeal Closure system using the “new Glue” as many patients recognize it on the internet. Restrictive insurance plans don’t like to recognize new proven technologies. Before Medicare or insurance companies authorize some procedures, they put restrictive clauses on treatment options: wearing compression stockings and conservative therapies for 3 months prior to therapy. Many of our patients have opted out of Medicare and insurance plans and choose a payment plan option where we can start right away! Many other treatment options can be found on our website @morrisonvein.com
Call today 480-775-8460 / 480-860-6455 and get started on your road to healthy, happy legs again. Come in for a screening and then a diagnostic ultrasound, so you know where you stand. We will teach you about your veins, measure your legs for “New and Improved” compression stockings or athletic compression socks to wear while you wait or decide what to do. http://www.morrisonvein.com Questions to firstname.lastname@example.org or morrisonveininstitute.com